Novitasphere Portal Overview

Part A and Part B

2019 IHS Partnership

Disclaimer

▪ All Current Procedural Terminology (CPT) only are copyright 2018 American MedicalAssociation (AMA). All rights reserved. CPT is a registered trademark of the AmericanMedical Association. Applicable Federal Acquisition Regulation/ Defense FederalAcquisition Regulation (FARS/DFARS) Restrictions Apply to Government Use. Feeschedules, relative value units, conversion factors and/or related components are notassigned by the AMA, are not part of CPT, and the AMA is not recommending theiruse. The AMA does not directly or indirectly practice medicine or dispense medicalservices. The AMA assumes no liability for data contained or not contained herein.

▪ The information enclosed was current at the time it was presented. Medicare policychanges frequently; links to the source documents have been provided within thedocument for your reference. This presentation was prepared as a tool to assistproviders and is not intended to grant rights or impose obligations.

▪ Although every reasonable effort has been made to assure the accuracy of theinformation within these pages, the ultimate responsibility for the correct submissionof claims and response to any remittance advice lies with the provider of services.

▪ Novitas Solutions’ employees, agents, and staff make no representation, warranty, orguarantee that this compilation of Medicare information is error-free and will bear noresponsibility or liability for the results or consequences of the use of this guide.

▪ This presentation is a general summary that explains certain aspects of the Medicareprogram, but is not a legal document. The official Medicare program provisions arecontained in the relevant laws, regulations, and rulings.

▪ Novitas Solutions does not permit videotaping or audio recording of training events.

Novitas Solutions IHS Education

▪ Education specific to Indian Health Services (IHS) providers in

Medicare Administrative Contractor (MAC) Jurisdiction H (JH), which

includes:

• Tribally owned and operated facilities electing to bill as IHS

• Tribally operated IHS facilities

• IHS owned and operated facilities

• Tribally owned and IHS operated facilities

▪ Tribally owned and operated facilities electing to bill the MAC

serving their specific geographic location should look to that MAC for

guidance on billing.

Acronym List

Acronym Definition

BOA Billing Office Approver

BOBA Billing Office Back-up Approver

EIDM Enterprise Identity Management

MBI Medicare Beneficiary Identifier

MFA Multi-Factor Authentication

NPI National Provider Identifier

OA Office Approver

OBA Office Back-up Approver

POA Provider Office Approver

POBA Provider Office Back-up Approver

PTAN Provider Transaction Access Number

Today’s Presentation

▪ Agenda:

• Novitasphere Portal:

✓ Portal Enrollment

✓ Features

▪ Objectives:

• Understand the benefits of using the Novitasphere portal

What is Novitasphere?

▪ Definition:

• Free, secured web-based Portal which allows enrolled users access to

time-saving features

▪ Purpose:

• Allows enrolled users access to Eligibility, MBI Lookup, Claim

Information, Remittance Advice, Appeal Requests, Medical Review

Records and much more

▪ For demonstrations and more information on Novitasphere visit:

• JH Providers

Novitasphere Features: Part A and

Part B (part 1)

Feature/Functionality Part A Part B

835 ERA x x

Appeals Development

Letter

x x

Claim Correction n/a x

History Corrections n/a x

Claim Status n/a x

Claim Summary n/a x

Comparative Billing

Report (CBR)

n/a x

Credit Balance Report

Submission

x n/a

Novitasphere Features: Part A and

Part B (part 2)

Feature/Functionality Part A Part B

Electronic Claim

Submission- Direct Data

Entry

n/a x

Electronic Claim

Submission- File Upload

x x

Eligibility x x

MBI Lookup Tool x x

Medial Review Claims

View Copies of ADR

letters and more

x x

Medical Review Records

Submission to ADR

Letters

x x

Novitasphere Features: Part A and

Part B (part 3)

Feature/Functionality Part A Part B

Overpayment Letters x x

Redetermination Notices x x

Retrieve Remittances

Advice Copies

n/a x

Submit Appeal Requests x x

Submit General

Information Requests

n/a x

Submit Immediate

Recoupments

x x

Submit Provider Audit &

Reimbursement

Documents

x n/a

Coming in 2019

▪ Provider Enrollment Welcome Letters (Part A & Part B)

▪ Paper Remittance Copies (Part A)

▪ Financial Information (Part B)

▪ Claim Status (Part A)

Portal Enrollment

Enroll with Three Basic Steps

Roles and Responsibilities

Office Approver (OA)

Does not have to be the

Provider/Owner

Office Back-up Approver

(OBA)

Does not have to be the

Provider/Owner

End User

Has access to all features Has access to all features Has access to all

features

Must be listed as the OA on

the EDI Portal Enrollment

form

Must be listed as the OBA on

the EDI Portal Enrollment form

Should NOT be listed on

the EDI Portal

Enrollment form

Responsible for creating the

Organization in EIDM

Will enroll in EIDM after the

OA has been approved

Will enroll in EIDM after

the OA has been

approved

Responsible for approving

all End Users access

request

Responsible for approving all

End Users access request

Access is granted by the

OA or OBA

Responsible for certifying all

End User access annually

Responsible for certifying all

End User access annually

Annual Certification

completed by OA/OBA

Enrollment Forms

▪ Step 1: Provider Novitasphere Enrollment form:

▪ Providers in JH will complete the 8292PJH

▪ Carefully follow the instructions for the completion of your form:

▪ Instructions for completing the form (JH)

▪ Step 1: Billing Service/Clearinghouse Novitasphere Enrollment form:

• JH Third Party billers will complete the 8291PJH

• Carefully follow the instructions for the completion of your form:

✓ 8291P/8291PJH instructions

EIDM Registration

▪ Provides user identity:

• Ensures only authorized/registered user can access protected

information

▪ Step 2: Office Approver (OA) will create a User ID and password

▪ Step 3: OA will request the appropriate Novitasphere role for access:

• Register a Multi-Factor Authentication (MFA) Device

▪ OBA and End Users will enroll for access under organization:

• OA or Office Backup Approver (OBA) MUST approve the EIDM request

for End Users

▪ Novitasphere Frequently Asked Questions:

• Part A

• Part B

EIDM Registration Information

▪ The Novitas Solutions’ EIDM Help Desk staff will approve or reject

the request:

• Approved:

✓ Will receive a confirmation email indicating the request has been processed

✓ You will now be able to log into the Novitasphere Portal

✓ Please allow 24 hours before attempting to log in:

➢ Novitasphere

• Rejected:

✓ You will receive an email detailing the rejection reason

▪ Novitasphere End Users will need to complete one additional step:

• Request/Confirm your POA/POBA (provider offices) or BOA/BOBA

(billing groups) has approved your EIDM request

Enrollment References

▪ Novitasphere Enrollment Form (JH)

▪ Third Party Novitasphere Enrollment Form (JH)

▪ EIDM Instructions (JH):

• EIDM Enrollment Overview Training Module

▪ MFA Device Instructions: (JH)

Keep your Novitasphere Access

Active

▪ All users must log in at least once every 30 days, or their

Novitasphere access will be removed

▪ Please feel free to print out this graphic to hang by your computer.

Tips to Maintain Access

▪ Set a recurring reminder on your calendar or phone

▪ Use the buddy system! Remind your colleagues to keep their access

active, and ask them to remind you too

▪ Review our new Novitasphere Log In Help document if you’re having trouble

successfully logging in

▪ Call for help:

• The Novitasphere Help Desk can assist with password issues, locked Multi-

Factor Authentication (MFA) devices, and adding additional MFA devices. That

number is 1-855-880-8424

▪ Sign up for the Novitasphere email lists. We don’t want to see you lose

your access – so we issue monthly reminders

▪ Check your vacation schedule. Log in before leaving if you will be out of the

office for an extended time

▪ Remember, logging into EIDM at portal.cms.gov to change your password,

or to approve End User access, does not satisfy this requirement:

• You must log in to https://www.novitasphere.com once every 30 days

Part A Navigation Bar

Part B Navigation Bar

Part A and B Eligibility Features

Eligibility Information

▪ Eligibility

o Part A and B Eligibility Effective and

Termination Dates

o End Stage Renal Disease (ESRD) dates and

information

▪ Deductible

o Part B Total Deductible Remaining for Calendar

year

o Occupational, Physical and Speech Therapy

amounts applied to the capitation limits

o Rehabilitation Session counts

▪ Medicare Advantage Plan (MAP)

o Contract Name, Number, Address and

Telephone Number

o Plan number and Plan name

o Type of Medicare Advantage Plan

o The Bill Option code of the Plan type

o Effective and Termination Dates

▪ Medicare Secondary Payer (MSP)

o The reason Medicare is secondary

o Effective and Termination Dates

o MSP Diagnosis code

o Name of Insurance Company and Address

▪ Hospice/Home Health

o Certification codes and dates

o Home Health Episode Start and End Dates

o Home Health Episode termination date

o Provider NPI Number of the Home Health Facility

▪ Preventive Services

o Number of Smoking Sessions remaining

o Medicare Diabetes Prevention Program (MDPP)

usage

o Preventive Service Procedure Code

o Preventive Technical and Professional Dates

o Deductible Applied for the Calendar Year

o Deductible Remaining for the Calendar Year

o Coinsurance Remaining for the Calendar Year

▪ Inpatient

o Date of earliest and latest billing activity for the spell

of illness

o Hospital Information

o Skilled Nursing Facility Information

▪ QMB

o QMB Effective and Termination Dates

o QMB Deductible and Coinsurance Remaining

QMB Inpatient Spell, Hospital Information and SNF

Information

Eligibility Details

Eligibility Results

Eligibility Tab

Deductible Tab

Medicare Secondary Payer (MSP)

Tab

Current Procedural Terminology (CPT) only copyright 2018 American Medical Association. All rights reserved.

Hospice/Home Health Tab

Current Procedural Terminology (CPT) only copyright 2016 American Medical Association. All rights reserved.

Preventive Tab

Current Procedural Terminology (CPT) only copyright 2018 American Medical Association. All rights reserved.

Inpatient Tab

MBI Lookup

▪ Select the MBI Lookup from the left navigation bar

Claim Submission/ERA

Part A Claim Submission

▪ Part A :

• Can upload only

Part A Claim Submission/ERA -

File Upload and Reports

Part A File Upload

Part A File Upload Selection

Part A File Upload Selection

Confirmation Screen

Part A File Status and Reports

Part A File Status and Reports

Selection

Part B Claim Submission

▪ Part B:

• Can upload or submit using Direct Data Entry (DDE)

Part B Claim Submission/ERA

Part B File Upload

Direct Data Entry Tool Bar Access

Direct Data Entry (DDE)

New Claim Entry Screen

Part B File Status and Reports

Selection

Part B Claims Status

Part B Claim Correction

Part B Claim Correction – Claim

Information

Part B Claim Correction – Header

Level

Part B Claim Correction – Line

Level

Part B Claim Correction - Submit

Part B Claim Correction

Confirmation

Part B Billed in Error

Part B Billed in Error - Continued

Part B Appeal Request

Part B Appeal Requests

Part B Appeal Request – Select

Lines

Part B Redetermination and

Clerical Error Reopening Request

Form

Part B Appeal Requests File Upload

Part A Retrieve Documents

Part A Overpayment Letter

Part A Redetermination Notices

Part B Retrieve Documents

Part B Overpayment Letter

Part B Redetermination Notice

Part B View Remittance Advice

Part B Requested Remittance

Advices

Part A Submit Documents

Part A Submit Documents – Appeal

Requests

Part A Appeal Requests Continued

Part A Appeals Request -

Redetermination and Clerical Error

Reopening Request Form

Part A Audit and Reimbursement

Part A Miscellaneous

Documentation Submission

▪ Cost Report Reopening: • Used for Submission of reopening

Requests for a cost report after it has been settled

▪ Cost Report Appeals: • Used for the submission of supporting

documents for cost reposts that are under appeal

▪ SSI Realignment Request (DSH):• Used to request an update to a provider’s

disproportionate share statistics

▪ Provider-Based Determination: • Used to request initial setup or change in

a unit’s provider-based status

▪ Wage Index/Occupational Mix Submissions:

• Used to upload documentation for the yearly wage index and occupational mix audits

▪ Desk Review/Audit Additional Documentation:

• Used to upload documentation requested by the Novitas audit staff during the time of a desk review and/or audit

▪ Submit FOIA Request: • Used to submit a Freedom of

Information Act request for Medicare cost reports

▪ Submit PS&R Request:• Used to submit a Provider Statistical &

Reimbursement report request for fiscal years not covered on the CMS PS&R online system. Providers may utilize this selection if they are currently experiencing PS&R access issues as well

▪ General Correspondence: • Used to submit documentation for

items not covered in the above-mentioned table selections; such items include: ✓ Request for Interim Rate Change

✓ Request for Tentative Settlement Change

✓ TEFRA Exception Request

✓ SCH Low Volume Request

✓ Request for Change in Statistical Basis

✓ CMS Tie-In-Notice

✓ Bankruptcy

✓ Other Supporting Documentation

✓ 50%Reduction Request

Part A Miscellaneous

Documentation Form

Part A CMS-838 Credit Balance

Report

Part A Immediate Recoupments

Part A Submission History

Part A Submission History -

Submission Results

Part B Submit Documents

Part B Immediate Recoupments

Submission History

Alerts, Updates and References

Alert & Updates

Contact Us

Live Chat

Novitasphere Portal Center Page

Novitasphere Portal Enrollment

Page

Novitasphere References

▪ Novitasphere Provider Portal Enrollment Overview Training Module

▪ Novitasphere User Manual

▪ Novitasphere Claims Correction Guide

▪ Novitasphere New User Checklist

Summary

▪ Reviewed Novitasphere Portal Enrollment and Features

Thank You

▪ Gail Atnip

Education Specialist, Provider Outreach and Education

Gail.Atnip@novitas-solutions.com

717-542-6349

▪ Kim Robinson

Education Specialist, Provider Outreach and Education

Kim.Robinson@novitas-solutions.com

717-542-6344

▪ Janice Mumma

Supervisor, Provider Outreach and Education

Janice.Mumma@novitas-solutions.com

717-526-6406

▪ Stephanie Portzline

Manager, Provider Engagement

Stephanie.Portzline@novitas-solutions.com

717-526-6317